V12-09 FEMALE URETHRAL LEIOMYOMA RESECTION AND JUGAL GRAFT URETHROPLASTY: STEPWISE VIDEO

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You have accessJournal of UrologyCME1 Apr 2023V12-09 FEMALE URETHRAL LEIOMYOMA RESECTION AND JUGAL GRAFT URETHROPLASTY: STEPWISE VIDEO Bruno Di Domenico, Arthur Degani Ottaiano, Fabio Franco Oliveira Junior, Natália Dalsenter Avilez, Joao Marcos Ibrahim de Oliveira, Jefferson Douglas Camargo Moreira, André Canettieri Rubez, Caio De Oliveira, Gabriel Chahade Sibanto Simoes, Lucas Mira Gon, and Cassio Luis Zanettini Riccetto Bruno Di DomenicoBruno Di Domenico More articles by this author , Arthur Degani OttaianoArthur Degani Ottaiano More articles by this author , Fabio Franco Oliveira JuniorFabio Franco Oliveira Junior More articles by this author , Natália Dalsenter AvilezNatália Dalsenter Avilez More articles by this author , Joao Marcos Ibrahim de OliveiraJoao Marcos Ibrahim de Oliveira More articles by this author , Jefferson Douglas Camargo MoreiraJefferson Douglas Camargo Moreira More articles by this author , André Canettieri RubezAndré Canettieri Rubez More articles by this author , Caio De OliveiraCaio De Oliveira More articles by this author , Gabriel Chahade Sibanto SimoesGabriel Chahade Sibanto Simoes More articles by this author , Lucas Mira GonLucas Mira Gon More articles by this author , and Cassio Luis Zanettini RiccettoCassio Luis Zanettini Riccetto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003347.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Leiomyoma is a benign tumor that originates from smooth muscle cells. Despite being the most common benign tumor in women, it is exceptionally uncommon in the urethra, with approximately 150 reported cases. The peak incidence is in the third and fourth decades. The symptoms are location and size related, usually affecting the proximal urethra with a mean diameter of 3.7 cm. The main signs and symptoms are mass sensation in the urethra, dyspareunia, irritative and obstructive urinary tract symptoms, hematuria, and acute urinary retention. Imaging tests such as ultrasound and magnetic resonance imaging (MRI) help diagnose and adequate surgical planning. Complete resection helps avoid recurrence, which may require urethral resection and reconstruction. METHODS: A 25-year-old patient with moderate intellectual disability reported vaginal bleeding for 15 days, despite using medroxyprogesterone acetate. Progressive growth of a perineal mass, incomplete bladder emptying sensation and straining were present for one year. She denied hematuria. There was a fixed and painless solid mass of 4×3 cm on the anterior vaginal introitus, with minor bleeding at the mobilization. MRI showed a solid and heterogeneous mass, measuring 4.4×3.2×2.4 cm and no defined cleavage plane with the urethra or anterior vaginal wall. A surgical intervention was proposed. Under general anesthesia, with the patient in the lithotomy position, a U-shape supra-meatal incision was made. Total en-bloc resection of the mass was performed, with an unsuccessful attempt at urethral preservation. The proximal margin was sent to frozen section biopsy with negative result to determine where to stop ressection. Jugal graft urethroplasty was performed using 5-0 polydioxanone. The pubourethral ligament was reconstructed with vycril 2-0. Closure of the vaginal mucosa was made with 2-0 vycril. RESULTS: An anatomopathological study revealed complete resection of leiomyoma. Patient was discharged on the first postoperative and had the Folley catheter removed after 3 weeks. At a four-month follow-up, there were no complications or recurrence of urinary symptoms. CONCLUSIONS: Urethral leiomyoma is a rare pathology, and there is no established protocol for its treatment. The challenge is resecting the lesion entirely while preserving the structures. It is crucial to reconstruct the urethra and connective tissue support to maintain adequate urinary function. Although it may prolong operation time, jugal graft urethroplasty is a feasible option for large leiomyomas. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1067 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bruno Di Domenico More articles by this author Arthur Degani Ottaiano More articles by this author Fabio Franco Oliveira Junior More articles by this author Natália Dalsenter Avilez More articles by this author Joao Marcos Ibrahim de Oliveira More articles by this author Jefferson Douglas Camargo Moreira More articles by this author André Canettieri Rubez More articles by this author Caio De Oliveira More articles by this author Gabriel Chahade Sibanto Simoes More articles by this author Lucas Mira Gon More articles by this author Cassio Luis Zanettini Riccetto More articles by this author Expand All Advertisement PDF downloadLoading ...